Division of Nephrology and Hypertension (J.N., L.O.L.), Mayo Clinic, Rochester, MN.
Department of Nephrology and Hypertension, Aarhus University Hospital, Aarhus, Denmark (J.N.).
Hypertension. 2022 Apr;79(4):717-725. doi: 10.1161/HYPERTENSIONAHA.121.17960. Epub 2022 Feb 9.
The collateral circulation can adapt to bypass major arteries with limited flow and serves a crucial protective role in coronary, cerebral, and peripheral arterial disease. Emerging evidence indicates that the renal collateral circulation can similarly adapt and thereby limit kidney ischemia in atherosclerotic renovascular disease. These adaptations predominantly include recruitment of preexisting microvessels for arteriogenesis, with de novo vessel formation playing a limited role. Yet, adaptations of the renal collateral circulation in renovascular disease are often insufficient to fully compensate for the limited flow within an obstructed renal artery and may be hampered by the severity of obstruction or patient comorbidities. Experimental strategies have attempted to circumvent limitations of collateral formation and improve the prognosis of patients with various ischemic vascular territories. These have included pharmacological approaches such as endothelial growth factors, renin-angiotensin-aldosterone system blockade, and I channel-blockers, as well as interventions like preconditioning, exercise, enhanced external counter-pulsation, and low-energy shock-wave therapy. However, few of these strategies have been implemented in atherosclerotic renovascular disease. This review summarizes current understanding regarding the development of renal collateral circulation in atherosclerotic renovascular disease. Studies are needed to apply lessons learned in other vascular beds in the setting of atherosclerotic renovascular disease to develop new treatment regimens for this patient group.
侧支循环可以适应有限血流的主要动脉旁路，并在冠状动脉、脑和外周动脉疾病中发挥关键的保护作用。新出现的证据表明，肾侧支循环也可以类似地适应，从而限制动脉粥样硬化性肾血管疾病中的肾脏缺血。这些适应主要包括募集预先存在的微血管进行动脉生成，而新血管形成的作用有限。然而，在肾血管疾病中，肾侧支循环的适应通常不足以完全补偿阻塞性肾动脉内的有限血流，并且可能受到阻塞的严重程度或患者合并症的阻碍。实验策略试图规避侧支形成的限制并改善各种缺血性血管区域的患者预后。这些策略包括内皮生长因子、肾素-血管紧张素-醛固酮系统阻断剂和 I 型通道阻滞剂等药理学方法，以及预处理、运动、增强型体外反搏和低能量冲击波治疗等干预措施。然而，这些策略中很少有在动脉粥样硬化性肾血管疾病中实施。这篇综述总结了目前对动脉粥样硬化性肾血管疾病中肾侧支循环发展的理解。需要进行研究，以便将在其他血管床中获得的经验教训应用于动脉粥样硬化性肾血管疾病患者群体，以开发新的治疗方案。
